Antibiotic-Resistant Bacteria Found in 37 U.S. States

Half a world away, doctors in India are fighting outbreaks of bacterial infections that are resistant to more than 15 types of antibiotics. But closer to home, a similarly scary bug is making the rounds in intensive care and other long-term units of American hospitals.

In at least 37 states, Washington, D.C., and Puerto Rico, doctors have identified bacteria, including E. coli, that produce Klebsiella pneumoniae carbapenemase, or KPC--an enzyme that makes bacteria resistant to most known treatments. It's much more prevalent in America than bacteria that produce NDM-1, the enzyme that has Indian doctors "hell scared," and, according to Alexander Kallen, a medical officer at the Centers for Disease Control in Atlanta, the final outcome isn't much different: superbacteria that are hard to kill.

"It's got a slightly different structure than [NDM-1]," he says of KPC. "But the bottom line is they're two different ways to produce bacteria that are resistant to a wide range of antibiotics."

[Hospital Rooms Crawling With Drug-Resistant Germs.]

That's bad news for infected patients--the mortality rate for patients infected with KPC-producing bacteria has been estimated to be as high as 50 percent. Doctors are advised to do their best to keep the bacteria from spreading, which explains why the problem is most prevalent in hospitals and other close-quarter medical units. Infected patients are often isolated.

KPC has been seen in a wide range of bacteria, including E. coli, Salmonella, and K. pneumonia, which often affects hospitalized patients.

These superbugs are resistant to nearly every weapon doctors can throw at them, including carbapenems, a class of antibiotic that the CDC calls the "last line of defense" against infections that are resistant to other types of antibiotics. There are a couple antibiotics that have been shown to kill these superbugs, but often at great risk to patients. In fact, the FDA has associated the use of these effective antibiotics with an "increased risk of death" in patients with pneumonia.

That leaves many doctors scratching their heads. KPC-bacteria often grow on medical equipment such as catheters and ventilators, so doctors can sometimes remove that equipment or perform surgery to try to eliminate the infection from a patient's body.

[Are Kids Brown-Bagging Bacteria?]

CDC researchers, including Kallen, say that hospitals who haven't been vigilant about isolating patients with KPC-producing bacteria may have missed their chance. According to a paper co-authored by Kallen released last year, "failure to recognize CRE infections when they first occur in a facility has resulted in a missed opportunity to intervene before these organisms are transmitted more widely."

The good news is that, at least for now, KPC-producing bacteria generally only infects people who already have compromised immune systems. "It can move into the wider community," says Kallen, "but we haven't seen much of that yet."

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Pot legalization efforts forge ahead in key states

(Reuters) - Efforts to legalize marijuana for recreational use are gaining momentum in Washington state and Colorado, despite fierce opposition from the federal government and a decades-long cultural battle over America's most commonly used illicit drug.

Officials in Washington state on Friday said an initiative to legalize pot has enough signatures to qualify for the ballot in November. In Colorado, officials are likely this week to make a similar determination about an initiative there.

Supporters are prepared to possibly spend millions of dollars ahead of the November ballot, when they hope a strong voter turnout, particularly among youth, for the U.S. presidential election will aid their cause.

"Whether it's make or break depends on what public opinion does after 2012, but in terms of voter turnout this is the best year to do it," said Alison Holcomb, director of New Approach Washington, the initiative's sponsor.

While 16 states, including Washington and Colorado, along with the nation's capital, now allow marijuana use for medical purposes, cannabis remains an illegal narcotic under U.S. law - and public opinion is sharply divided on the merits of full legalization.

California voters turned back a ballot initiative to legalize marijuana for recreational use in 2010, in part because of concerns about how production and sale of the drug would be regulated.

Since then, the U.S. Department of Justice has cracked down on medical cannabis operations in California, Washington state and elsewhere, raiding dispensaries and growing operations and threatening landlords with prosecution.

"Our highest priority are the folks that violate both state and federal law," said Rusty Payne, spokesman for the Drug Enforcement Administration. "There are places that have made a lot of money who claim to be nonprofit, and they have faced both local and federal scrutiny."

Undeterred, supporters of the Washington state initiative say it represents the "grown-up" approach to legalization.

Sales would only be allowed to adults 21 and older through marijuana-only stores licensed by the state Liquor Control Board, which would also oversee production and processing of the drug. Laws on drunken driving would be amended to include maximum blood content thresholds for THC, the main psychoactive element in pot plants.

Colorado already has a robust regulatory system for medical marijuana that includes a registry of over 80,000 card-carrying patients and rules governing how physicians and distributors operate. Here, too, legalization advocates are stressing a rational regulatory approach.

"Voters aren't being asked to imagine as much as they are in other states, they have seen that marijuana can be regulated and it doesn't result in significant problems," said Mason Tvert, co-director of the Colorado-based Campaign to Regulate Marijuana Like Alcohol.

Organizers of the Washington effort have collected over $1.1 million in campaign funds, with $250,000 of that coming from Progressive Insurance chairman Peter Lewis, public disclosure records show.

Loren Collingwood, senior researcher for the nonpartisan Washington Poll run by the University of Washington, said the initiative could pass, but that backers must spend between $2 million and $4 million to run a competitive campaign.

A poll done by the university in October found 48 percent of Washington residents support the idea of pot legalization, but that was not tied to any particular initiative.

"If young voters turn out in droves like they did in 2008 or even start to approach those numbers ... then I think this will pass, but they very well may not," Collingwood said.

NATIONAL SHIFT

Pot legalization supporters have argued for decades that prohibition has failed to curb pot use, and that the policy enriches drug cartels, hurts casual users and deprives governments of a potentially lucrative source of tax revenue.

Now, they see momentum on their side, pointing to an October Gallup Poll that found a record 50 percent of Americans support legalizing marijuana use, up from 36 percent five years before.

The poll also found 62 percent of those between the ages of 18 and 29 back legalization, and that the young are driving the shift in attitudes.

"There's a set of factors that suggest both the Washington and Colorado initiates have a better chance of winning than any of the initiatives that have happened before," said Ethan Nadelmann, executive director of the Drug Policy Alliance.

"But that said, even with a majority of likely voters in both states saying they favor legal marijuana, we know in the final stretch there's always a small percentage that get nervous or scared off or fearful of change," he said.

Opponents of legalization, meanwhile, say it would simply promote the use of a sometimes-addictive drug that has been linked to short-term memory loss and other behavioral problems such as lack of motivation.

Legalization "is not good for states and citizens who live in those states, and it's certainly not good for the outlook of children who live in those states," said Calivina Fay, head of the Florida-based Drug Free America Foundation.

One study published in 2011 by researchers with the University of Colorado Denver found 39 out of 80 teens in a Denver substance abuse program had at least once obtained pot from someone with a medical marijuana license.

LOCAL OPPOSITION

For supporters of legalization, the medical marijuana trade has been a mixed blessing. Critics say dispensaries, in addition to serving the truly sick, supply recreational users who have no real medical problems despite claims of backaches or pain.

In Washington state, about 30 or 40 cities have passed moratoriums on collective medical marijuana gardens allowed under state law, said Jim Doherty, legal consultant for the Municipal Research and Services Center of Washington. Some residents see medical marijuana sales as a nuisance, he said.

Meanwhile, Seattle has over 100 medical marijuana shops, said City Attorney Peter Holmes, who supports full legalization.

"Right now in Seattle, we're feeling that it's a bit unfair that we are being tolerant of medical marijuana users, when other localities are not, because we tend to become suppliers for the whole state rather than our own citizens," Holmes said.

Holcomb, the director of the Washington state initiative campaign, acknowledged some voters view a large share of medical pot users as illicit recreational tokers. But she said her campaign will turn the argument around, when it seeks to convince voters full legalization is good for the state.

"You're ending that hypocrisy and restoring respect for the law," she said.

(Reporting By Alex Dobuzinskis; Editing by Jonathan Weber)

Continue Reading... Labels: ahead, efforts, forge, legalization, states

Mentally ill flood ER as states cut services

CHICAGO/NEW YORK (Reuters) - On a recent shift at a Chicago emergency department, Dr. William Sullivan treated a newly homeless patient who was threatening to kill himself.

"He had been homeless for about two weeks. He hadn't showered or eaten a lot. He asked if we had a meal tray," said Sullivan, a physician at the University of Illinois Medical Center at Chicago and a past president of the Illinois College of Emergency Physicians.

Sullivan said the man kept repeating that he wanted to kill himself. "It seemed almost as if he was interested in being admitted."

Across the country, doctors like Sullivan are facing a spike in psychiatric emergencies - attempted suicide, severe depression, psychosis - as states slash mental health services and the country's worst economic crisis since the Great Depression takes its toll.

This trend is taxing emergency rooms already overburdened by uninsured patients who wait until ailments become acute before seeking treatment.

"These are people without a previous psychiatric history who are coming in and telling us they've lost their jobs, they've lost sometimes their homes, they can't provide for their families, and they are becoming severely depressed," said Dr. Felicia Smith, director of the acute psychiatric service at Massachusetts General Hospital in Boston.

Increased demand in mental health services

http://link.reuters.com/sud75s

State mental health budget cuts

http://link.reuters.com/tud75s

Visits to the hospital's psychiatric emergency department have climbed 20 percent in the past three years.

"We've seen actually more very serious suicide attempts in that population than we had in the past as well," she said.

Compounding the problem are patients with chronic mental illness who have been hurt by a squeeze on mental health services and find themselves with nowhere to go.

On top of that, doctors are seeing some cases where the patient's most critical need is a warm bed.

"The more I see these patients, the more I realize that if it's sleeting and raining outside, the emergency room is the only place they have," said Dr. R. Corey Waller, director of the Spectrum Health Medical Group Center for Integrative Medicine in Grand Rapids, Michigan.

Government agencies such as the National Institutes of Mental Health, the Centers for Disease Control and Prevention and the Substance Abuse and Mental Health Services Administration could not provide fresh data on use of psychiatric services in recent years.

But doctors from more than a dozen hospitals nationwide, mental health advocacy groups and state-funded agencies told Reuters they are all seeing a marked increase in psychiatric emergencies.

A WORSENING PROBLEM

The National Association of State Mental Health Program Directors (NASMHPD), an organization of state mental health directors, estimates that in the last three years states have cut $3.4 billion in mental health services, while an additional 400,000 people sought help at public mental health facilities.

In that same time frame, demand for community-based services climbed 56 percent, and demand for emergency room, state hospital and emergency psychiatric care climbed 18 percent, the organization said.

"This wasn't one round of cuts," says Ted Lutterman, director of research analysis at NASMHPD Research Institute. "It was three or four for many states, and multiple cuts during the year."

If the economy doesn't improve, next year could be worse because many community mental health agencies are cutting programs and using up reserve funds, says Linda Rosenberg, president of the National Council for Community Behavioral Healthcare.

"It's been horrible," she said. "Those that need it the most - the unemployed, those with tremendous family stress - have no insurance."

In the emergency room, this increased demand has meant doctors and social workers are spending hours and sometimes days trying to arrange care for psychiatric patients languishing in the emergency department, taking up beds that could be used for traditional types of trauma.

More than 70 percent of emergency department administrators said they have kept patients waiting in the emergency department for 24 hours, according to a 2010 survey of 600 hospital emergency department administrators by the Schumacher Group, which manages emergency departments across the country.

Ten percent said they had "boarded" patients for a week or more.

And many hospitals are not prepared for the increased caseload of psychiatric patients, says Randall Hagar, director of government affairs for the California Psychiatric Association.

California cut $587 million in state-funded mental health services in the past two years, the most of any state, according to the National Alliance on Mental Illness, a patient advocacy group.

"They don't have secure holding rooms. They don't have quiet spaces. They don't have a lot of things you need to help calm down a person in an acute psychiatric crisis," Hagar said.

"Often you have a patient strapped to a gurney in a hallway outside of the emergency department where social workers are desperately trying to find an inpatient bed," he said.

FROM CITIES TO SMALL TOWNS

In North Carolina, the state has cut its inpatient psychiatric capacity by half since 2005, says Dr. Bret Nicks, an emergency physician at Wake Forest Baptist Medical Center in Winston-Salem and a spokesman for the American College of Emergency Physicians.

Nicks points to a report from the Institute of Medicine released in 2006 that found U.S. emergency departments were already overtaxed and overcrowded.

"Now you are adding in patients who are unsafe to leave but yet have nowhere to go," he said. "I consider patients with acute psychiatric needs as really the forgotten patient population in the U.S. right now."

Dr. Stephen Anderson is an emergency department doctor at Auburn Regional Medical Center, a mid-size suburban hospital outside of Seattle.

"When the economy is hurt they are some of the first to drop off the healthcare rolls," he said of local residents in the largely blue-collar community.

Anderson, who heads the Washington Chapter of the American College of Emergency Physicians, said the state has lost a third of its inpatient psychiatric beds in the past decade.

Lately he is seeing a marked escalation in patients with psychiatric problems turning up in the emergency department. In early December, a third of its beds were occupied with people in a psychiatric crisis who were not safe to return to the community.

The problem extends out to small towns.

Sullivan splits his time between the big emergency department at the University of Illinois Medical Center at Chicago and St. Margaret's Hospital, a tiny facility in Spring Valley, Illinois, about 100 miles southwest of the city.

On a recent shift, a young woman with schizophrenia arrived at the hospital. She had just lost her job and apartment and was living with relatives. She could not afford the medications that were keeping her illness in check.

The woman asked Sullivan to switch her prescriptions to drugs that could be found on the $4 discount list at Wal-Mart and other discount stores.

"I didn't feel comfortable doing that," Sullivan said, noting that emergency physicians are being asked to deliver specialized care that should be handled by a psychiatrist.

He found a healthcare facility about 25 miles away with a psychiatrist who could help, but even that presented a problem for the woman, who had no way of getting to the appointment.

"It's almost akin to having a cardiac patient come in and say, 'I need someone to adjust my defibrillator.' In the emergency department, we can do a lot, but there are some things we have to leave with the specialists," he said.

(Editing by Michele Gershberg and Eric Beech)

Continue Reading... Labels: flood, Mentally, services, states